Am I at Risk?
Everyone is at some risk for melanoma, but increased risk depends on several factors: sun exposure, number of moles on the skin, skin type and family history (genetics).
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Both UVA and UVB rays are dangerous to the skin, and can induce skin cancer, including melanoma. Blistering sunburns in early childhood especially increase risk, but sunburns later in life and cumulative exposure also may be factors. People who live in locations that have more sunlight — like Florida, Hawaii, and Australia — develop more skin cancers, but some more northern locations with light-skinned populations also have a high number of skin cancers. Avoid using a tanning booth or tanning bed, since it increases your exposure to UV rays, raising your risk of developing melanoma and other skin cancers.
There are two kinds of moles: normal moles — the small brown blemishes, growths, or "beauty marks" that appear in the first few decades of life in almost everyone — and atypical moles, also known as dysplastic nevi. Atypical moles can be precursors to melanoma and having them puts you at increased risk of developing the disease. But regardless of type, the more moles you have, the greater your risk. People with 50 or more moles are considered to be at increased risk of developing melanoma.
As with all skin cancers, people with fairer skin (who often have lighter hair and eye color as well) are at increased risk. Do you know your skin type? Click here to take our Skin Type Quiz.
Weakened Immune System
Compromised immune systems as the result of chemotherapy, an organ transplant, excessive sun exposure, and diseases such as HIV/AIDS or lymphoma can increase your risk of melanoma.
Heredity plays a major role in melanoma. About one in every 10 patients diagnosed with the disease has a family member with a history of melanoma. If your mother, father, siblings or children have had a melanoma, you are in a melanoma-prone family. Each person with a first-degree relative diagnosed with melanoma has a 50 percent greater chance of developing the disease than people who do not have a family history of the disease.
Close Relatives Examined
When this skin cancer is diagnosed, it is standard practice for physicians to recommend that close relatives be examined immediately for melanoma and for the presence of unusual or atypical moles. These moles are also called "dysplastic nevi." Some physicians today will also recommend that you and your family be tested for germline (hereditary) mutations predisposing to skin cancer.
When atypical moles are found in an individual belonging to a melanoma family, the condition is known as FAMMM, standing for Familial Atypical Multiple Mole Melanoma Syndrome. People with this syndrome are at the greatest risk of developing melanoma. In contrast, a research study found that those family members who did not have atypical moles were much less likely to develop melanoma.
Genetic Risk Factors
A mutation (alteration) in a gene called BRAF can play a part in causing many melanomas. This mutated gene is found in about half of all melanomas. BRAF is called a "switch" gene, because mutations can turn it on abnormally, leading to uncontrolled cell growth and cancer. The discovery of BRAF was an exciting research breakthrough, and with the development of the drug vemurafenib (Zelboraf™), FDA-approved in 2011 to inhibit BRAF, physicians and patients began to reap rewards. Increasing understanding of the BRAF gene could lead to the development of new diagnostic tools and has already led to approval of several new and improved drug therapies.
The mutations most commonly seen in familial melanoma occur in another gene, p53. When this gene is in its normal state, it functions as a tumor suppressor, giving damaged cells the chance to repair themselves without progressing to cancer. However, when the gene is altered, it becomes unable to perform this function, and cancer can result. Complicating matters, new research shows that the same ultraviolet (UV) damage that produces skin damage can damage p53, causing the alterations that eliminate its ability to suppress tumors.
A number of gene mutations in addition to p53 and BRAF have been associated with familial melanoma, notably the CDKN2A (cyclin-dependent kinase inhibitor 2A) gene and the MC1R (melanocortin-1 receptor) gene, which is associated with skin and hair pigment. Loss-of-function mutations in MC1R result in red hair color, lighter skin color, greater sun sensitivity and a higher propensity to melanoma and other skin cancers.
As time goes on, more families are being screened to identify those members who are carrying a defective gene. If, as a result, they become particularly vigilant in watching their moles and having regular total-body skin examinations, they will most often detect melanomas at the earliest stages, when the chances of a cure are excellent. Testing is now commercially available for the presence or absence of the CDKN2A gene, but the consensus of melanoma experts is that genetic testing is not yet warranted for most people.
Moles in an Active Stage
Moles in people belonging to melanoma-prone families are subject to change at certain times of life. They may get larger or show alterations in color or elevation, so for those periods, they are described as being active. While the reasons for these changes are not fully known, there could be a hormonal component: Moles are more active at puberty and during pregnancy. Many — but not all — physicians advise high-risk individuals not to take hormonal medications, such as oral contraceptives or hormone replacement therapy.
Individuals with atypical mole syndrome or a personal or family history of skin cancer can improve their chances of early detection by increasing the frequency of skin self-examination and by visiting a physician more often (two or more times a year) for a full-body skin exam. The clinician may take photographs to document whether there are new moles or changes in older ones.
Children: a Special Case
Children in melanoma-prone families need special care, because familial melanoma is likely to make its appearance early in life. Even though these cancers usually do not appear until after adolescence, they may arise in much younger children who have a family history of melanoma. Most physicians, therefore, advise parents to make a point of studying a child's skin frequently from infancy on.
Physician examination in these families should start at the age of 10 and continue on a twice-a-year basis thereafter. Particular care should be taken at puberty and during adolescence when hormonal changes activate the moles. Here is some encouraging news: Because melanoma families are on the lookout for the disease and seek professional consultation early, the survival rate for familial melanoma is even higher than that for non-familial melanomas.